Being accompanied to liver discharge clinic: An easy measure to identify potential liver transplant candidates among those previously considered ineligible.

BACKGROUND: Patients with cirrhosis deemed ineligible for liver transplantation are usually followed in general hepatology or gastroenterology clinics, with the hope of re-evaluation once they meet the appropriate criteria. Specific strategies to achieve liver transplant eligibility for these patients have not been studied. AIM: To assess clinical and sociodemographic factors associated with future liver transplant eligibility among patients initially considered ineligible. METHODS: This is a retrospective study of patients with cirrhosis considered non-transplant eligible, but without absolute contraindications, who were scheduled in our transitional care liver clinic (TCLC) after discharge from an inpatient liver service. Transplant candidacy was assessed 1 year after the first scheduled TCLC visit. Data on clinical and sociodemographic factors were collected. RESULTS: Sixty-nine patients were identified and the vast majority were Caucasian men with alcoholic cirrhosis. 46 patients (67%) presented to the first TCLC visit. Seven of 46 patients that showed to the first TCLC visit became transplant candidates, while 0 of 23 patients that no-showed did (15.2% vs 0%, P = 0.08). Six of 7 patients who showed and became transplant eligible were accompanied by family or friends at the first TCLC appointment, compared to 13 of 39 patients who showed and did not become transplant eligible (85.7% vs 33.3%, P = 0.01). CONCLUSION: Patients who attended the first post-discharge TCLC appointment had a trend for higher liver transplant eligibility at 1 year. Being accompanied by family or friends during the first TCLC visit correlated with higher liver transplant eligibility at 1 year (attendance by family or friends was not requested). Patient and family engagement in the immediate post-hospitalization period may predict future liver transplant eligibility for patients previously declined.

Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: A qualitative study of a bridge clinic.

BACKGROUND: A minority of patients with substance use disorder (SUD) receives treatment, indicating the need for innovation in care for individuals with SUD. Transitional and low threshold models of care for SUD are utilized to address this treatment gap, but there is limited evidence about their effectiveness or patient perspectives on these models. METHODS: Patients participated in semi-structured interviews (N = 29) which explored their experience in a transitional, low threshold, Bridge clinic for the treatment of SUD. In order to reach a diverse patient population across age, gender, housing status, type of SUD, length of stay, and patient status in the clinic, researchers employed maximum variation sampling. Interviews were conducted until no new central concepts emerged. Codes were developed and assigned using an inductive as well as a mixed inductive-deductive approach. RESULTS: Patients identified flexibility and accessibility of services, compassionate approach of providers and staff, use of peers in recovery, and the emphasis on harm reduction as positive features of the model. Patients struggled with transitioning out of the clinic. CONCLUSION: Patients reported positive experiences in a transitional, low threshold clinic for SUD, comparing it favorably to other programs. Patients maintained sobriety more consistently and increasing motivation to adhere to treatment. Patients almost universally appreciated the flexible and harm reduction-oriented model of treatment. Future quantitative research is needed to further examine the effects of low threshold programs on treatment outcomes, including ongoing substance use, treatment retention and overdose mortality, as compared to traditional treatment programs.